advertisement

Editors Selection IGR 12-3

Surgery: Tube implantation through ciliary sulcus

Comment by Francisco Fantes on:

26650 Glaucoma tube shunt implantation through the ciliary sulcus in pseudophakic eyes with high risk of corneal decompensation, Weiner A; Cohn AD; Balasubramaniam M et al., Journal of Glaucoma, 2010; 19: 405-411

Find related abstracts

Tube shunt insertion through the ciliary sulcus have been advocated in patients that have had cataract surgery to improve corneal transplant survival in reports by Tello et al.¹ and Rumelt et al.² The procedure has the advantage of positioning the tube farther away the corneal endothelium therefore avoiding the possibility of mechanical trauma, and avoiding the need of a vitrectomy in cases such as shallow anterior chambers Weiner et al. (1421) performed a retrospective, non comparative study in pseudophakic patients with high risk of corneal decompensation. It looks at a larger number of patients than previously reported, and more specifically at post-operative corneal status, and outcome endpoints, including intraocular pressure reduction. A total of thirty-six eyes were found with a follow-up ranging from 4.0 to 58.5 months. The study high risk group included patients with previous corneal transplants, guttata,edema, and shallow chambers. From a total of 30 pre-operative clear corneas, only one decompensated. From seven corneal transplanted corneas, six remained clear. Regarding the intraocular pressure outcome the results showed a significant pressure reduction where 34 out of 36 eyes had lowering of 30% or more from their initial pressure. Regarding complications, most were in line with previous shunt surgery reports. The exception was that 10 out of 36 eyes had small post-operative hyphemas. Hyphemas were 0.5 to 2.0 mm, and most cleared up within one and two weeks. One patient with neovascular glaucoma required a wash out. The value of the study is in the number of patients, reproducible technique, favorable outcomes in safety and effectivity when compared with the literature. The limitations are well outlined by the authors: lack of control group, and randomization, and being a retrospective review. This is an interesting study that is really worthwhile to pay attention.

• ← Previous
• Next →